Healthcare Provider Details

I. General information

NPI: 1558663195
Provider Name (Legal Business Name): SOLOMON BENJAMIN BOYCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GOLF COURSE RD STE E
LOGAN UT
84321-5934
US

IV. Provider business mailing address

2141 W 1000 N
TREMONTON UT
84337-9362
US

V. Phone/Fax

Practice location:
  • Phone: 435-799-5035
  • Fax:
Mailing address:
  • Phone: 435-512-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11895001-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: